Citation Nr: 9910703
Decision Date: 04/16/99 Archive Date: 04/29/99
DOCKET NO. 97-25 026 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Medical Center in Salt Lake
City, Utah
THE ISSUE
Entitlement to reimbursement for the cost of unauthorized
medical expenses incurred in connection with private medical
treatment received on June 20, 1994.
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
D. M. Fogarty, Associate Counsel
INTRODUCTION
The veteran had active duty from January 1942 to April 1945.
FINDINGS OF FACT
1. The veteran is service-connected for tinnitus,
hypertrophy of the turbinates, high frequency bilateral
hearing loss, and anxiety neurosis by history. He has no
other adjudicated service-connected disabilities.
2. The veteran was treated in the emergency room of a
private hospital on June 20, 1994, for a complaint of
dizziness and to rule out a stroke or myocardial infarction.
3. There is no competent evidence showing that dizziness,
stroke, or myocardial infarction are in any way related to
the veteran's adjudicated service-connected disabilities.
4. The veteran is not permanently or totally disabled.
5. The veteran is not a participant in Chapter 31
rehabilitation.
CONCLUSION OF LAW
Payment or reimbursement by the Department of Veterans
Affairs (VA) for the cost of unauthorized medical expenses
incurred in connection with the veteran's private medical
treatment on June 20, 1994 is precluded by law. 38 U.S.C.A.
§ § 1728, 5107(a) (West 1991); 38 C.F.R. § 17.120 (1998).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
Pertinent Law and Regulation
The legal criteria governing the conditions under which the
cost of unauthorized non-VA medical expenses will be paid or
reimbursed by VA are explicit. These legal criteria are set
forth in 38 U.S.C.A. § 1728 and 38 C.F.R. § 17.120. The
latter provides:
To the extent allowable, payment or reimbursement of the
expenses of care, not previously authorized, in a
private or public (or Federal) hospital not operated by
the VA, or of any medical services not previously
authorized including transportation (except prosthetic
appliances, similar devices, and repairs) may be paid on
the basis of a claim timely filed, under the following
circumstances:
(a) For veterans with service-connected
disabilities:
(1) For an adjudicated service-connected
disability;
(2) For nonservice-connected disabilities
associated
with and held to be
aggravating an adjudicated
service-connected
disability;
(3) For any disability of a
veteran who has a total
disability permanent in
nature resulting from a
service-connected
disability (does not apply outside
of the States,
Territories, and possessions of the
United States, the
District of Columbia, and the
Commonwealth of Puerto Rico); or
(4) For any illness, injury or dental
condition in the
case of a veteran who is
participating in a
rehabilitation program
under 38 U.S.C.A. Chapter
31 and is medically
determined to be in need of
hospital care or medical
services for any of the
reasons enumerated in
38 C.F.R. § 17.48(j) (1998);
and
(b) Care and services not previously authorized
were rendered
in a medical emergency of such
nature that delay would have
been hazardous to life or
health,
and
(c) VA or other Federal facilities were not
feasibly available, and
an attempt to use them
beforehand or obtain prior VA
authorization for the services
required would not have been
reasonable, sound, wise, or
practicable, or treatment had been
or would have been refused.
It is important to note that all three of the preceding
criteria must be satisfied before payment or reimbursement
for unauthorized medical expenses can be made. See 38 C.F.R.
§ 17.120.
Factual Background
In the instant case the veteran is service-connected for
tinnitus, hypertrophy of the turbinates, high frequency
bilateral hearing loss, and anxiety neurosis by history. He
has no other adjudicated service-connected disabilities.
On June 20, 1994, the veteran received emergency room
treatment at Eastern Idaho Regional Medical Center, located
in Idaho Falls, Idaho. The emergency room report indicates
the veteran complained of dizziness and light-headedness.
Continuous ringing in the ears was also noted. It was noted
that the veteran did not complain of weakness, numbness, or
difficulty speaking. It was also noted that the veteran had
not been vomiting, had not had chest pain, belly pain, or
shortness of breath. The veteran denied any ongoing medical
problems. An impression of "symptoms of uncertain
etiology" was noted. It was further noted that it did not
appear that the veteran had myocardial infarction and he had
no acute stroke syndrome, although he might have had a
transient ischemic attack.
In a March 1996 letter, the Chief of Medical Administrative
Service informed the veteran that his request for
reimbursement had been reviewed and it was determined that
the treatment rendered was not for a service-connected
disability; therefore reimbursement was not authorized.
VA Form 10-583(R) dated in April 1996 reflects a VA
determination that the private medical treatment received by
the veteran on June 20, 1994 was not for any service-
connected disability or for a disability related to any
service-connected disability, that the veteran was not
permanently and totally disabled and that he was not
participating in rehabilitation under 38 U.S.C.A. Chapter 31.
Thus, his claim for reimbursement was disapproved.
In a letter dated in June 1996, the veteran stated that his
dizziness was caused by drinking several cans of soda while
watching television at night. The veteran further stated he
stayed up watching television because he could not sleep due
to the ringing in his ears. Thus, the veteran contends his
treatment was related to a service-connected disability.
Analysis
It is clear that the veteran was not treated on June 20,
1994, for his service-connected tinnitus, hypertrophy of the
turbinates, high frequency bilateral hearing loss, or anxiety
neurosis. There is no competent evidence showing that light
headedness or dizziness, myocardial infarction, stroke, or a
transient ischemic attack are in any way associated with or
held to have been aggravating any of the veteran's
adjudicated service-connected disabilities. The veteran is
not permanently and totally disabled from a service-connected
disability. Additionally, there is no evidence the veteran
is participating in a rehabilitation program under
38 U.S.C.A. Chapter 31.
Accordingly, the veteran has not met the initial criteria for
the reimbursement for unauthorized medical expenses.
38 C.F.R. § 17.120(a). As all three criteria must be met for
eligibility under 38 C.F.R. § 17.120, the Board of Veterans'
Appeals (Board) need not address 38 C.F.R. § 17.120 (b), (c).
The Board has carefully reviewed the entire record of the
case; however, this is a case in which the law is
dispositive, and the appeal must therefore be denied.
Sabonis v. Brown, 6 Vet. App. 426 (1994).
ORDER
Entitlement to payment or reimbursement by VA for the cost of
unauthorized medical expenses incurred in connection with the
veteran's private medical treatment on June 20, 1994, is
denied.
John E. Ormond, Jr.
Member, Board of Veterans' Appeals